Your Update Form

Tell me what’s going on since we last met and what you want to work on? All fields optional unless otherwise indicated. Filling out this form helps me to be more effective in your session.

Name

First Name

Last Name

Which points do you have sealed?

Chiron Point

Point of Fortune

Black Moon Point

Vertex Point

Was your most recent dream more than 7 days ago?

Mark yes, only if you have not dreamt in the past week while sleeping.

Yes

Which sensations got better since we our last session? Approximate in the last week or days, on a scale of 0 to 10.

0 = gone, 10 = worst ever. (e.g., Back Pain = 5, Flu = 2, Depression = 0)

Which sensations got worse since our last session? Approximate in the last week or days, on a scale of 0 to 10.

What daily suggestions did you follow?

e.g., use healing master in aroma lamp, or none.

Since our most recent meeting, is anything new in your lifestyle?

e.g., stress, routine, work, etc?

List any physical discomforts.

e.g., neck pain, cramps, headaches, sores, spasms, etc.

List any emotional, mental or spiritual discomforts.

e.g., depression, unhappy, confused, stressed, fearful, etc.

What is the priority topic you want to address today?

Please indicate any recent or chronic pain.

More Information

e.g., other therapies or activities are more effective, you need dream interpretation, etc.